Fukuhara Shinichi, Ibrahim Michael, Dohle Daniel, Bavaria Joseph E
Department of Cardiac Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI USA.
Division of Cardiovascular Surgery, University of Pennsylvania, 3400 Spruce Street, 6 Silverstein, Philadelphia, PA 19104 USA.
Indian J Thorac Cardiovasc Surg. 2019 Jun;35(Suppl 2):96-105. doi: 10.1007/s12055-018-0674-7. Epub 2018 May 3.
With the proliferation of non-invasive thoracic imaging modalities, the question of when to operate on asymptomatic ascending aortic aneurysms for non-syndromic patients is becoming increasingly relevant. Operation is extensive, often involves circulatory arrest, and subjects the patient to significant risk of mortality and morbidity. Surgery is performed to avert fatal aortic adverse events, which carry a markedly poor prognosis. The question of when the balance is tipped toward preemptive surgical repair is challenging and is centered around predicting the risk of an acute aortic syndrome. Size of the aneurysm has been the traditional guide for decision-making but how this is measured, what risks it truly predicts, the influence of the patient's size, valve morphology, genetic profile, and other risk factors for non-syndromic patients are poorly understood. We here review this issue in detail.
随着无创胸部成像技术的不断普及，对于非综合征型患者无症状升主动脉瘤何时进行手术的问题变得越来越重要。手术范围广泛，通常涉及循环停止，且患者面临着显著的死亡和发病风险。进行手术是为了避免致命的主动脉不良事件，这些事件的预后明显很差。何时权衡利弊倾向于进行预防性手术修复是一个具有挑战性的问题，其核心在于预测急性主动脉综合征的风险。动脉瘤大小一直是传统的决策指南，但对于如何测量动脉瘤大小、它真正预测的风险、患者体型、瓣膜形态、基因特征以及非综合征型患者的其他风险因素的影响，我们知之甚少。我们在此详细回顾这个问题。
